Standard versus tubeless percutaneous nephrolithotomy: a systematic review.

Abstract:

OBJECTIVE:This article systematically analyses comparative studies to evaluate the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL) versus standard PCNL. METHODS:The Medline, EMBASE, PsycINFO, Cochrane and DARE databases were searched from 1997 to February 2011. Comparative studies evaluating outcomes from standard versus tubeless PCNL were included. Primary outcome measures were post-operative pain scoring, analgesic requirements, duration of hospitalisation/convalescence, operation time, major/minor complications and stone-free rates. RESULTS:Twenty-four studies were included (11 randomised control trials and 13 retrospective or prospective studies). Levels of pain recorded, analgesic requirements, duration of inpatient stay and convalescence time were all significantly reduced in the tubeless PCNL group. Cost was reduced in two studies. Morbidity was not significantly different between the groups. There was no significant difference between groups regarding stone-free status. DISCUSSION:This systematic review has demonstrated that tubeless PCNL is a viable alternative to tubed PCNL in uncomplicated cases. Benefits are as described above. There is no evidence suggesting that patient safety is compromised by the absence of post-operative nephrostomy. The tubeless method has been reported in challenging cases such as stag-horn stones, horseshoe or ectopic kidneys. Promising outcomes have been demonstrated in elderly patients and when clinical needs demand a supracostal approach. Multi-centre randomised controlled trials are needed to fully establish the effectiveness of the tubeless method.

journal_name

Urol Int

journal_title

Urologia internationalis

authors

Amer T,Ahmed K,Bultitude M,Khan S,Kumar P,De Rosa A,Khan MS,Hegarty N

doi

10.1159/000336145

subject

Has Abstract

pub_date

2012-01-01 00:00:00

pages

373-82

issue

4

eissn

0042-1138

issn

1423-0399

pii

000336145

journal_volume

88

pub_type

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